It’s not just the menopause that can cause vagi­nal dry­ness. GH in­ves­ti­gates the causes that can af­fect mil­lions of women and finds the most im­por­tant thing you can do for your gy­nae health

‘What­ever the cause of vagi­nal dry­ness, no one needs to just put up with it’

Maybe it’s be­cause of where it’s stocked in shops – next to the con­doms – but most of us think of lu­bri­cant as some­thing to try only when our sex lives are be­ing af­fected by vagi­nal dry­ness. This is not the case.

It’s es­ti­mated that mil­lions of women suf­fer from vagi­nal dry­ness for a whole range of rea­sons, in­clud­ing com­mon med­i­cal con­di­tions, the side ef­fects of cer­tain drugs, some can­cer treat­ments, as well as any changes that re­duce lev­els of the hor­mone oe­stro­gen. The most com­mon change is menopause, but it can also be other things, like breast-feed­ing.

‘Vagi­nal dry­ness can af­fect women at a whole range of ages and cause a lot of mis­ery,’ says Dr David Ed­wards, a spe­cial­ist in sex­ual prob­lems and past pres­i­dent of the Bri­tish So­ci­ety for Sex­ual Medicine, who co-au­thored a pa­per on the treat­ment of vagi­nal dry­ness. ‘Yet few women seek help – re­search sug­gests fewer than one in four – be­cause of em­bar­rass­ment or be­cause they think it’s too triv­ial to bother a doc­tor with.’

While vagi­nal dry­ness can be due to sev­eral fac­tors and may be tem­po­rary, it is also the main symp­tom of vagi­nal at­ro­phy, which is a per­ma­nent change and one of the last big taboos sur­round­ing menopause. With­out oe­stro­gen, the lin­ing of the vagina thins and loses its elas­tic­ity, and the vagi­nal canal be­comes shorter. The vulva area, blad­der and ure­thra are af­fected in the same way mak­ing uri­nary tract in­fec­tions, ur­gent or fre­quent loo trips and stress in­con­ti­nence (when you leak a bit as you cough or ex­er­cise) more com­mon. Joy all round, in other words!

What­ever the cause of vagi­nal dry­ness, no one needs to just put up with it, says Dr Ed­wards – and un­der­stand­ing why it’s hap­pen­ing, how to choose the right vagi­nal mois­turiser and lu­bri­cant, and whether lo­cal oe­stro­gen can help are the first steps to sort­ing out your gy­nae health.

Rea­sons you might be feel­ing dry…

While menopause is the most com­mon cause, vagi­nal dry­ness can be due to many other fac­tors. ‘A big group that is un­der­diag­nosed is women with type 2 di­a­betes,’ says Dr Ed­wards. ‘Just as diabetic men can be prone to erec­tile dys­func­tion be­cause dam­age to tiny blood ves­sels re­stricts blood flow, the same prob­lem can af­fect women, so blood flow to the vagina and cli­toris is lim­ited. The re­sult is an in­abil­ity to be­come prop­erly aroused, and you don’t get the lu­bri­ca­tion you would nor­mally.’

Vagi­nal dry­ness can also be a side ef­fect of sev­eral med­i­ca­tions, in par­tic­u­lar an­tide­pres­sants, which can re­duce li­bido in both men and women. Se­lec­tive sero­tonin re­up­take in­hibitors (SS­RIS), like flu­ox­e­tine (Prozac), can cause vagi­nal dry­ness and re­duced sen­si­tiv­ity, though this varies in in­di­vid­u­als. Asthma, allergy and cold med­i­ca­tions con­tain­ing an­ti­his­tamines can also have a dry­ing ef­fect, as they may re­duce vagi­nal se­cre­tions.

Any­thing that stops ovu­la­tion, ei­ther tem­po­rar­ily or per­ma­nently, there­fore re­duc­ing oe­stro­gen lev­els, can cause dry­ness. This is true of breast-feed­ing but also anorexia or ex­treme weight loss as a re­sult of ill­ness. Con­tra­cep­tive in­jec­tions, such as Depo-provera, can also be a fac­tor, as they pre­vent ovu­la­tion.

Treat­ment for en­dometrio­sis, a con­di­tion where tis­sue lin­ing the womb grows out­side the womb, or even for se­vere pre­men­strual ten­sion may switch off ovar­ian func­tion, tem­po­rar­ily caus­ing dry­ness.

Can­cer pa­tients are an­other group who may be af­fected, as chemo­ther­apy can bring on the menopause, as can ra­dio­ther­apy to the pelvis or lower ab­domen. This can also make the vagi­nal tis­sues stiff and less elas­tic.

A rare but un­pleas­ant au­toim­mune con­di­tion called Sjö­gren’s syn­drome, which af­fects about half a mil­lion peo­ple in the UK, mainly women aged 40 to 60, dam­ages the body’s se­cre­tory glands pre­vent­ing tears and saliva, as well as se­cre­tions of the vagina and gas­troin­testi­nal tract.

It’s also pos­si­ble that anx­i­ety can some­times be linked to vagi­nal dry­ness. ‘We do some­times see women whose pe­ri­ods have stopped as a re­sult of stress, though it’s not clear what causes this,’ says Dr Heather Cur­rie, as­so­ciate spe­cial­ist gy­nae­col­o­gist at Dum­fries and Gal­loway Royal In­fir­mary and MD of Menopause Mat­ters (menopause­mat­ters.co.uk).

It’s also worth high­light­ing that chem­i­cal prod­ucts like fem­i­nine sprays, shower or bath prod­ucts may cause ir­ri­ta­tion to the sen­si­tive skin of the vulva in in­di­vid­u­als, rather than vagi­nal dry­ness, says Dr Cur­rie.

Sex, drugs and per­sonal chem­istry

Not ev­ery­one suf­fers from vagi­nal at­ro­phy post-menopause, and an ac­tive love life will help the vagina main­tain elas­tic­ity and sup­ple­ness, as fric­tion dur­ing in­ter­course stim­u­lates cells lin­ing the vagina to re­gen­er­ate. No part­ner? Solo sex­ual stim­u­la­tion helps, too, as it in­creases blood flow to the tis­sues and pro­vides lu­bri­ca­tion.

While hor­mone re­place­ment ther­apy (HRT) can help with tem­po­rary menopause symp­toms like hot flushes, it is not rec­om­mended for the long term, and

‘Few women seek help be­cause of em­bar­rass­ment’

[con­tin­ued from pre­vi­ous page] vagi­nal at­ro­phy is a per­ma­nent con­di­tion that will re­turn once you stop. Us­ing top­i­cal oe­stro­gen in and around the vagina, how­ever, is a long-term treat­ment op­tion.

While it is some­times re­ferred to as top­i­cal HRT, Dr Heather Cur­rie says, ‘HRT is oe­stro­gen plus or mi­nus pro­ges­terone, which cir­cu­lates through the whole body. Vagi­nal oe­stro­gen is quite dif­fer­ent as there is no pro­ges­terone and the ab­sorp­tion into the body is min­i­mal and not as­so­ci­ated with the same is­sues as HRT.’

Vagi­nal oe­stro­gen can be pre­scribed as a cream (Ovestin and Gynest are brand names), as vagi­nal tablets in­serted with an ap­pli­ca­tor (brand name: Vag­ifem) usu­ally used ev­ery night for two weeks then twice a week, or as a ring po­si­tioned in the vagina that re­leases oe­stro­gen and lasts three months (brand name: Estring).

As well as restor­ing tis­sues, treat­ment also re­bal­ances the ph level of the vagina, which be­comes less acidic when oe­stro­gen lev­els drop. This means a ‘good’ type of bac­te­ria, lac­to­bacilli, can’t thrive and other bac­te­ria mul­ti­ply, mak­ing in­fec­tions like bac­te­rial vagi­nosis more likely.

Us­ing top­i­cal oe­stro­gen cream, vagi­nal tablets or a ring can also help di­min­ish uri­nary prob­lems, such as urge or stress in­con­ti­nence, and can help to re­duce the num­ber of uri­nary in­fec­tions, al­though these will need an­tibi­otic treat­ment.

What you can do: mois­turis­ers v lubes

If the ad­vent of Vi­a­gra was the an­swer to erec­tile dys­func­tion, then the cre­ation of mois­turis­ers and lu­bri­cants specif­i­cally for vagi­nal use is the cor­re­spond­ing an­swer for women, says Sarah Brooks, co-founder of Yes range of or­ganic prod­ucts (yesyesyes.org). Dis­cov­er­ing that most lu­bri­cants con­tained po­ten­tially harm­ful in­gre­di­ents in­spired her and busi­ness part­ner Susi Len­nox to sell their houses to fund re­search to de­velop an or­ganic, eth­i­cal prod­uct.

Some prod­ucts are avail­able on pre­scrip­tion but, if you’re buy­ing your­self, the first step is to un­der­stand the dif­fer­ence be­tween a mois­turiser and a lu­bri­cant. ‘Mois­turis­ers are de­signed for reg­u­lar use to hy­drate the vagi­nal tis­sues,’ says Dr David Ed­wards, who stud­ied the com­po­si­tion of dif­fer­ent brands used to treat vagi­nal at­ro­phy. ‘They can be used ev­ery day to once a week as re­quired. Lu­bri­cants are short act­ing for use dur­ing sex to pro­vide wet­ness when the nor­mal arousal process doesn’t work so well.’

A key fac­tor in both is their ph value, which should match that of the vagina. If it’s too high or too low, it can cause ir­ri­ta­tion. In a healthy per­son, the nor­mal vagi­nal ph value is be­tween 3.8 and 4.5, and the World Health Or­ga­ni­za­tion rec­om­mends lu­bri­cants and mois­turis­ers within this range. Avoid sil­i­cone or min­eral oil-based mois­turis­ers, which don’t have a ph, and in­stead go for a wa­ter or plant-oil based one. You should find the ph on the pack­ag­ing. Mois­turis­ers with a ph be­low 4.5 in­clude Vag­isan, Sylk, Yes, Regelle, and Re­plensmd. You may need to ex­per­i­ment to find one that suits you best.

Help af­ter can­cer treat­ment

Women who are un­der­go­ing treat­ment for breast can­cer can be un­pre­pared to find vagi­nal dry­ness is an­other prob­lem, es­pe­cially as they try to rekin­dle sex­ual de­sire. ‘This is prob­a­bly the least-spo­ken­about and least-re­ported symp­tom,’ says Carolyn Rogers, se­nior clin­i­cal nurse spe­cial­ist at Breast Can­cer Care. ‘Partly be­cause women have left hos­pi­tal by the time it’s a prob­lem, and also they may feel em­bar­rassed to bring it up or that it is triv­ial in com­par­i­son to hav­ing a breast can­cer di­ag­no­sis.’

She rec­om­mends us­ing vagi­nal mois­turis­ers reg­u­larly to keep tis­sues hy­drated, and lu­bri­cants dur­ing in­ti­macy, which are best used by both part­ners.

Us­ing vagi­nal oe­stro­gen needs to be dis­cussed with an on­col­o­gist on a case-by­case ba­sis, but Carolyn says women tak­ing ta­mox­ifen may be safely pre­scribed it, as the ta­mox­ifen is thought to coun­ter­act any oe­stro­gen that may en­ter the blood­stream.

For those tak­ing an aro­matase in­hibitor, vagi­nal oe­stro­gen is not usu­ally rec­om­mended, but it may be pos­si­ble for some women to switch to ta­mox­ifen af­ter a dis­cus­sion with their on­col­o­gist.

For more in­for­ma­tion and to find out about face-to-face sup­port, visit breast­cancer­care.org.uk, or call its ex­pert nurses free on 0808 800 6000.